Overweight and obesity are recognized as chronic medical conditions. As such, they often require life-long treatment. Weight loss medications are effective for the “loss” phase but make a huge difference in the maintenance phase too. Let’s discuss…
I know this can sound strange to many of you who may think a person should be able to rely on willpower and lifestyle in order to be successful with losing weight. Although nutrition and physical activity are absolutely important, along with mindset and habit change, weight regain is a problem.
For most people who attempt to lose weight, they face weight regain in the months after. This is not because they lacked willpower.
First, we need to recognize that weight goes beyond aesthetics and appearances.
I firmly believe that people of all shapes and sizes deserve respect and can practice good health habits. We cannot use weight as the only measure of health as people can have health at different sizes. Weight stigma is a real problem in our society and in the medical field.
We do know; however, that weight (specifically excess body fat) plays a role in certain disease risks for people. There is an increased risk with excess body weight for many medical conditions like prediabetes, diabetes, fatty liver, obstructive sleep apnea, certain weight related cancers like post-menopausal breast, endometrial, liver, gall bladder and colon. So weight optimization really is about long term health, not fitting into a dress for an event : )
So why are weight loss and maintenance so difficult?
Weight regulation is a complex process. The hypothalamus is the area of the brain that is responsible for regulating weight and metabolism. The brain tightly regulates body weight around a “set point.”
Our brain, intestines, pancreas, liver and fat cells (adipose tissue) are in constant communication through hormones and neurotransmitters. These hormones impact hunger, appetite, cravings, fullness and food noise, making weight maintenance difficult. Learn more about the weight set point theory.
This is why losing weight through eating less and moving is difficult.
Maintenance after weight loss is even harder due to the body’s tendency to go “backwards” towards the “set point. It does this by slowing metabolic rate, increasing hunger hormones and reducing satiety or fullness hormones.
Once a person has gained excess body fat, it can be much harder to work against these hormonal changes. It is not your “failure” if this has happened to you!
For many people, the additional tool using weight loss medications is a game-changer.
How weight loss medications can improve your health
Getting to a healthier weight improves metabolic health (a healthy weight for an individual is NOT based on a magical number on the scale or BMI). Are you curious about your body composition? We offer Inbody 570 testing to measure visceral fat, fat mass and muscle and track it over time. Request an Inbody
We determine optimal weight based on body composition, improvement in weight-related medical conditions, and needing less medication for diabetes, high blood pressure or cholesterol. Improved labs and better day to day function in life are also indicators of better health after weight loss.
If repeat cycles of loss and regain sound familiar, you have experienced this weight biology first hand. It is hard emotionally and physically.
Weight loss medications help address the hormonal piece that is not in your direct control.. and help free you from loss and regain cycles. So many patients share how freeing it was to not deal with constant hunger or food noise AND be able to maintain weight without as much “white knuckling”!
Which weight loss medications can help?
New research on these complex pathways is leading to many new medications in the pipeline when it comes to weight loss medications. We use currently FDA-approved medications for weight management in day to day practice. Each weight loss medication works in a different way to help you lose weight. As a specialist, I stay on top of new developments and when deemed to be safe and effective, incorporate new tools into patient care plans.
In order to track weight and how health parameters are improving in our practice, we measure body composition to work on body fat loss and muscle gain. We look at labs to understand the status of your metabolic health. We create customized treatment plans based on your medical conditions, health risks and consideration of factors like side effect profile and cost.
Our team provides nutrition counseling and behavioral counseling to support body fat loss for the long-term.
We work to find the optimal weight loss medication and lifestyle regimen for patients. We follow our patients closely in order to adjust medication doses, change medication if needed, and follow progress.
Additionally, we help our patients make dietary changes that help reduce side effects of injectable GLP-1 medications like semaglutide and tirzepatide, and provide crucial guidance on how to maintain muscle mass, which is important when losing weight on injectable medications. We want our patients feel their best while achieving their goals!
As an obesity specialists we go beyond algorithms that provide everyone with the same medication prescription. Instead, we prescribe treatment based on a thorough medical history and personalized lifestyle & habits history. We use all the tools available to us, and one size does not fit all.
FDA-approved weight loss medications are:
- Zepbound (Tirzepatide)
- Saxenda (Liraglutide)- now generic
- Wegovy (Semaglutide)
- Qsymia (Phentermine/Topamax)
- Contrave (Naltrexone/Wellbutrin)
- Alli (Orlistat)
- Phentermine/diethylpropion
If the above medications are not ideal for our patients, we can prescribe different combinations of these medications, as well some components of these medications, for example Topamax or Wellbutrin alone. We can manage insulin resistance with metformin if appropriate. We are experienced in managing injectable medications like semaglutide- Wegovy, Ozempic and tirzepatide- Zepbound or Mounjaro. On average, people who take prescription weight loss medications as part of a lifestyle program, lose between 3-9 % more of their starting body weight than those who in a lifestyle program alone. Some people lose 20% or more, especially on injectables, depending on their particular situation.
We decide on which weight loss medications to use based on your medical evaluation and insurance coverage/cost considerations.
Of note, a part of your medical evaluation will be to review your current medications and ensure they are not contributing to weight gain. We help identify these weight positive medications so you can seek alternatives.
Last, as you lose weight, it is important that we closely monitor you from a medical standpoint. For patients with type 2 diabetes and high blood pressure in particular, we make the required dose adjustments to other medications in so you can avoid low blood sugar or low blood pressure.
Could you be a GLP-1 weight loss medication non-responder?
Could you be part of the 10% of people who are “non-responders” who don’t lose weight when using GLP-1 injections (semaglutide and tirzepatide)? It can be frustrating if you have been hearing about all the successful weight loss others may be experiencing while not losing weight on them yourself. Or maybe you have tried them and the side effects were unbearable… Is the cost of being on an injectable medication like semaglutide or tirzepatide weighing you down? We have other options!
GLP-1 medications like semaglutide and tirzepatide (Ozempic, Mounjaro, Wegovy & Zepbound) are popular weight loss medications. These medication are highly effective typically but about 10% of people in the studies were “non-responders” . This combined with national shortages is an important reason to know we have other weight loss medication options. As a specialist, I work with my patients to find alternatives.
It is my joy as a certified lifestyle medicine physician to not only provide science-based medical management, but also to guide my patients in practicing a healthy lifestyle addressing their nutrition, physical activity, sleep, stress coping, mindset and habits.
It is important to consider WHY some people benefit from medication, WHAT medication to use and WHO is managing your care so you can get the most effective and SUSTAINABLE treatment for your long-term whole body health.
In health,
Richa Mittal MD
